Long-term outcomes of perioperative myocardial infarction/injury after non-cardiac surgery
Christian Puelacher, Danielle Menosi Gualandro, Noemi Glarner, Giovanna Lurati Buse, Andreas Lampart, Daniel Bolliger, Luzius A. Steiner, M Grossenbacher, Katrin Burri‐Winkler, Hatice Gerhard, Elisabeth A. Kappos, Olivier Clerc, Laura Biner, Zaza Zivzivadze, Christoph Kindler, Angelika Hammerer‐Lercher, Miodrag Filipovic, Martin Clauss, Lorenz Gürke, Thomas Wolff, Edin Mujagić, Murat Bilici, Francisco Akira Malta Cardozo, Stefan Osswald, Bruno Caramelli, Christian Mueller, for the BASEL-PMI Investigators, Reka Hidvegi, Michael Freese, Ketina Arslani, Samantha Weder, Silvia Maiorano, Katharina Rentsch, Andreas Buser, Sandra Mitrović, Ivo Strebel, Esther Seeberger, Didier Lardinois, Stefan Schaeren, Rebecca Meister, Mirjam Pargger
Abstract
AIMS: Perioperative myocardial infarction/injury (PMI) following non-cardiac surgery is a frequent cardiac complication. Better understanding of the underlying aetiologies and outcomes is urgently needed. METHODS AND RESULTS: Aetiologies of PMIs detected within an active surveillance and response programme were centrally adjudicated by two independent physicians based on all information obtained during clinically indicated PMI work-up including cardiac imaging among consecutive high-risk patients undergoing major non-cardiac surgery in a prospective multicentre study. PMI aetiologies were hierarchically classified into 'extra-cardiac' if caused by a primarily extra-cardiac disease such as severe sepsis or pulmonary embolism; and 'cardiac', further subtyped into type 1 myocardial infarction (T1MI), tachyarrhythmia, acute heart failure (AHF), or likely type 2 myocardial infarction (lT2MI). Major adverse cardiac events (MACEs) including acute myocardial infarction, AHF (both only from day 3 to avoid inclusion bias), life-threatening arrhythmia, and cardiovascular death as well as all-cause death were assessed during 1-year follow-up. Among 7754 patients (age 45-98 years, 45% women), PMI occurred in 1016 (13.1%). At least one MACE occurred in 684/7754 patients (8.8%) and 818/7754 patients died (10.5%) within 1 year. Outcomes differed starkly according to aetiology: in patients with extra-cardiac PMI, T1MI, tachyarrhythmia, AHF, and lT2MI 51%, 41%, 57%, 64%, and 25% had MACE, and 38%, 27%, 40%, 49%, and 17% patients died within 1 year, respectively, compared to 7% and 9% in patients without PMI. These associations persisted in multivariable analysis. CONCLUSION: At 1 year, most PMI aetiologies have unacceptably high rates of MACE and all-cause death, highlighting the urgent need for more intensive treatments. STUDY REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT02573532.